| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,316 |
4,145 |
$21K |
| D1120 |
Prophylaxis - child |
2,232 |
2,196 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
628 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
655 |
634 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,758 |
3,768 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
931 |
914 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,694 |
1,647 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
726 |
693 |
$278.33 |
| D1206 |
Topical application of fluoride varnish |
460 |
454 |
$165.50 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
52 |
$0.00 |
| D1330 |
|
177 |
173 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$0.00 |
| D1999 |
|
31 |
28 |
$0.00 |